중간 병기의 간세포암종 환자의 예후 향상을 위한 고려점

Abstract

Hepatocellular carcinoma (HCC) is one of major malignant tumor with heterogeneity and poor prognosis. In contrast to other solid malignant tumors, the prognosis of HCC is affected by not only progression of tumor itself but also residual liver function. Therefore, diverse staging systems are developed in HCC and there was no universal consensus for best staging system. However, Barcelona Clinic Liver Cancer (BCLC) system, which was endorsed by Western expert guidelines, is most commonly used staging system. BCLC system defined intermediate stage as single tumor more than 5cm, 2-3 tumor more than 3cm or ≥ 4 tumor at any size with Child-Pugh A or B and performance status 0-1 and allocated transarterial chemoembolization (TACE) as primary treatment for this stage. Intermediate stage include heterogeneous patients population and inevitably showed diverse prognosis. Among HCC patients, about 20% belonged to intermediate stage and intermediate stage means relatively little progressed stage, fair liver function and performance status. Therefore, improvement of survival of intermediate HCC patients may be a cornerstone leading improvement of survival of overall HCC patients. Hence, the strategy for optimal classification and treatment modality for intermediate HCC patients at pre and post treatment to improve prognosis in this patients will be discussed in this review. (J Liver Cancer 2014;14:80-88)